Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 29057 | CA |
Y | 103TC0700X | Clinical Psychologist | 29057 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2012482 | CA |
NPI | 1134528573 |
---|---|
Provider Name | Dr. Daniel Anderson |
First Address | Los Angeles, CA 90034-3710 |
Second Address | Los Angeles, CA 90034-3710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 22/03/2017 |